Objectives: This study used cross-sectional data from the SEARCH for Diabetes in Youth study collected in 2015-2019 to evaluate associations between Household food insecurity (HFI) and depression among youth and young adults (YYA) with type 1 diabetes (T1D) or type 2 diabetes (T2D).

Methods: HFI was categorized as a binary variable (food secure vs food insecure) using the 18-item USDA food security survey, where ≥3 affirmations indicated being food insecure. The 20-item Center for Epidemiologic Studies Depression (CES-D) scale was used to quantify depression symptoms as a continuous outcome (scores 0-60). Linear regression models were adjusted for age, sex, race/ethnicity, site, and diabetes duration. Models were analyzed separately for youth with T1D, young adults with T1D, and young adults with T2D.

Results: HFI and CES-D data were available for 335 T1D youth (10-17 years), 731 T1D young adults (18-35 years), and 272 T2D young adults (18-34 years). Of these, 18.8%, 17.5%, and 30.1%, respectively, reported being food insecure. Adjusted models showed that food insecure young adults with T1D had 7.4 higher scores on symptoms of depression (p<.0001) and those with T2D had 4.8 higher scores on symptoms of depression (p=0.0002), when compared to those that were food secure. Food insecure youth with T1D had 3.2 higher scores on symptoms of depression compared to food secure youth with T1D after adjustment for covariates (p=0.0031).

Conclusions: Findings from this study suggest that living in a food insecure household is associated with increased depression symptomology among YYA with T1D or T2D.

Objectives: The Newest Vital Sign (NVS) is a widely used, interviewer-administered health literacy measure with 6 questions involving interpretation of an ice cream nutrition label. We examined the internal reliability and construct validity of a self-administered version of the NVS for use in online, population-based surveys in the US and Mexico.

Methods: In 2018 and 2019, nationwide cross-sectional surveys were conducted with online panels of adult consumers in Mexico (N=8,445) and the US (N=8,809). For each country, reliability was assessed via the Kuder-Richardson 20 formula (i.e., KR-20 for dichotomous indicators) and linear, multinomial logistic, and logistic models were estimated for three versions of the NVS: continuous (range=0-6), ordinal (0-1; 2-3; 4-6), and dichotomous variables (0-3; 4-6), the latter two of which are recommended by NVS developers. Convergent validity was examined for socioeconomic status and engagement with nutrition labels.

Results: The NVS exhibited high internal reliability (KR-20 US=0.83; Mexico=0.77). In linear regression models, higher education (p<.001), lower food insecurity (p<.001), more frequent exposure to nutrition labels (p<.001), more frequent use of nutrition labels (p<.001) and greater self-reported comprehension of nutrition labels (p<.001) were all associated with greater health literacy. Multinomial logistic and logistic regression models showed consistent results.

Conclusions: The NVS appears to have high reliability and strong construct validity for measuring nutrition label literacy in self-administered surveys among adult consumers in both Mexico and the US.

Objective: The purpose of this study was to explore and describe how the COVID-19 pandemic influenced dietary behaviors among adults enrolled in an internet-based weight loss program.

Methods: Adults enrolled in an internet-delivered weight loss program completed a semi-structured interview via telephone between June 1, 2020 and June 22, 2020. The interview explored how the COVID-19 pandemic has influenced dietary behaviors. Constant comparative analysis was used to identify key themes.

Results: Participants (n=30) were primarily female (83%) and white (87%), 54.6±10.0 years old, and had a mean body mass index of 31.1±4.5 kg/m2. General themes with eating were change in eating out frequency or modality (e.g., take out more, not eating at restaurants), cooking more, and changes in alcohol consumption. Themes related to shopping included change in shopping frequency, and inability and changes in ability to find certain foods. Barriers included snacking/ease of access to food, eating as a coping mechanism, and lack of routine/planning. Facilitators included calorie control, regular routine/scheduling, and self-monitoring.

Conclusion: The coronavirus pandemic has influenced adults eating and grocery shopping behaviors. As the COVID-19 pandemic continues, addressing these barriers will be critical for weight management. Disseminating strategies to promote healthy snack alternatives, flexible meal plans that account for challenges purchasing food at the grocery store, and stress management techniques to reduce stress eating may be helpful for those managing their weight. Future research is needed to understand the long term effects the pandemic may have on eating and shopping behaviors.

Background: Patients with Ulcerative Colitis (UC) experience a range of gastrointestinal (GI) and extraintestinal symptoms that generate a significant burden on daily life. Many patients seek out complementary treatments and undertake socio-behavioral and lifestyle adaptations to self-manage disease symptoms, reduce dependence upon pharmaceuticals, and respond to the challenges of living with chronic illness. This study will describe patient perspectives and experiences with UC treatment and self-management methods.

Methods: Qualitative data were collected using individual semi-structured interviews to reflect the perspectives and experiences of individuals with UC on treatment and self-management methods. Patients were recruited through Greenville’s Prisma Health Gastroenterology department, the Carolina’s Crohn’s and Colitis support group, and Facebook support groups. Eligibility criteria included: 1) diagnosis of UC; 2) duration of illness ≥5 years; and 3) minimum of one disease flare during the illness trajectory. Interviews were audio recorded and transcribed. Thematic analysis was conducted using NVivo 11 software.

Results: Progressive use of medications in response to disease flares was common. Participants identified stress as a precursor to disease flares. While some patients doubted the effect of diet on disease activity, the majority of participants spoke about foods as culprits for GI symptoms. Other participants described making changes to their dietary intake to manage their overall health. Patients who underwent colorectal surgery described a continuing need to self-manage gastrointestinal symptoms.

Conclusion: Participants expressed a spectrum of attitudes and approaches towards dietary change. Greater understanding is needed to identify how diet can influence immune functioning and overall health among UC patients.

Objective: This study examined 1) the separate relationships between socioeconomic disadvantage and the density of multiple types of food outlets, and 2) the relationships between socioeconomic disadvantage and composite positive and negative food outlet indices.

Methods: Cross-sectional data were analyzed using geospatial kernel density techniques. Food outlet data included convenience stores, discount and drug stores, fast food and fast-casual restaurants, and grocery stores. Multivariate linear regression was used to examine the relationships between socioeconomic disadvantage and density of food outlets. The unit of analysis was block groups, and all data about neighborhood socioeconomic disadvantage and food outlets were publicly available.

Results: Convenience store density, negative food environment index, and positive food environment index were positively associated with block group socioeconomic disadvantage, while total food environment index was negatively associated with block group socioeconomic disadvantage.

Conclusions: Those who reside in more disadvantaged block groups have greater access to both positive and negative food outlets. Although disadvantaged populations have greater access to all types of food outlets, the density of unhealthy establishments was greater than the density of grocery stores in these areas. Structural changes are needed to address access to healthy food outlets to combat environmental injustice and reduce obesity risk.

Objective: The objective of this study was to investigate the association between consumer behaviors related to purchasing of food/meals and Dietary Inflammatory Index (DII®) scores.

Methods: Cross-sectional data from adults over 12 years (N = 27,438) from the 2005 through 2016 National Health and Nutrition Examination Survey (NHANES) were used. DII scores were assessed according to 24-hour dietary recalls, while consumer behaviors were evaluated according to participants' responses to NHANES items related to food shopping and food expenditures. Regression analyses were conducted to examine the association between consumer behaviors and DII scores.

Results: While controlling for covariates, those in quartile 1 for spending money on groceries in a month (i.e., lowest amount) compared to quartile 4 for money spent on groceries has statistically significant higher DII scores (0.38 vs. 0.13, p<0.01). The converse was true for money spent dining out. Also, statistically significant higher DII scores were associated with having no fruits at home compared to always having fruits at home, as well as always having soda at home versus never having soda at home. Eating at restaurants, not using myPyramid, not using nutrition facts labels and not buying organic foods also were significantly associated with higher DII scores.

Conclusions: These findings suggest that consumers who spend less on grocery food, spend more money dining out, or do not use food nutrition information/education are more likely to consume more pro-inflammatory diets.

Mycotoxin contamination of baby foodstuffs is considered one of the most important chemical contaminants, as it causes many chronic health risks. This contamination leads to the spread of foodborne pathogens and infant death. Baby food microbial contamination may be a result of the incomplete manufacturing process and lack of knowledge about its preparation. Our studies explored the presence of mycotoxins produced by Aspergillus (Aflatoxin B1, B2, G1, G2 &M1), Fusarium (Deoxynivalenol) and Penicillium (Antibiotics) in baby food products manufactured and produced in lower and middle-income countries such as India. These studies also reveal that mycotoxin mitigation is key to improving child nutrition and growth, and that action is urgently required. A total of seventeen commercially available food samples manufactured by different manufacturers were obtained randomly from different retail stores in India and analyzed for this study. These food samples were of various types that included infant food (5 products-cereals, cornflakes, cerelac, milk powder), nutritional drinks (5 products), snacks, and breakfast foods (7 products). A total of 70 g from each sample were used for quantitative analysis of aflatoxins B1, B2, G1, G2, and aflatoxin M1 by using a previously established direct competitive enzyme-linked Immunoassay (ELISA). Mycotoxins in the samples were extracted using a chloroform: methanol extraction method. Our findings showed that all of the analyzed baby food samples were contaminated with aflatoxin M1 at a level exceeding the recommended European Union level of 25ng kg-1. Several (75%) of them contained detectable concentrations of deoxynivalenol and 51.7% samples with DON levels that can lead to dietary intake higher than 1 μg kg−1 recommended by the joint FAO/WHO expert committee on food additives. Our significant research on mycotoxins suggests that chronic exposure to mycotoxin contaminated complementary foods can put infants and toddlers at risk of acute aflatoxicosis and liver disease. It also reveals the urgent need for the global community to act now to reduce mycotoxin contamination and exposure to help some of our most vulnerable populations, infants, and children.

Objective: Identifying the predictors of early child development in populations is important to inform the design of interventions and programs. Using data from the BRISC trial, we examined the biopsychosocial correlates of development in 8 month-old Bangladeshi children.

Methods: This study includes children who participated in a baseline survey for a randomized controlled trial to study the effects of iron supplements and multiple micronutrient powders on child development. We recruited 3300 children at 8 months of age. Child development was assessed using the Bayley Scales of Infant and Toddler Development-III, psychosocial stimulation was measured using the Family Care Indicators (FCI), and maternal depression using the short version of Centre for Epidemiological Studies-Depression questionnaire. Anthropometry and hemoglobin concentrations were measured using standard procedures. A multiple variable linear regression model was used to examine significant correlates of cognitive, language, and motor development.

Results: In this population of 8 month old children, prevalence of anemia was 44.6% and stunting was 21.8%. In the adjusted model, length-for-age z-score (LAZ) and FCI score were significantly (p-value<0.01) associated with the cognitive development score [b (95%CI): LAZ = 0.94 (0.59, 1.28); FCI score = 0.12 (0.03, 0.21)]. Results were similar for language and motor development. Hemoglobin concentration was significantly associated with motor development [b (95%CI): LAZ = 0.39 (0.04, 0.73)], but not with cognitive and language development after adjustment for confounders.

Conclusions: Strategies to address the underlying causes of growth faltering and programs to improve parenting and home stimulation could have important implications for child development in Bangladesh.

Objective: This study examined the presence of healthy foods in the home at different time points during the COVID-19 pandemic among food insecure (FI) and food secure (FS) households.

Methods: Parents of elementary age children (2-5th grade) were surveyed in April 2020 and July 2020 about the presence of food items currently in their home. Food items were identified as ‘healthy’ according to the Healthy Eating Index. FI was assessed using the two-item USDA screener. A 2x2 repeated measures ANOVA was conducted to examine changes in the presence of healthy food in the household by FI status.

Results: Data were obtained from 62 households; 30% (n=19) were classified as FI. There were no significant main effect differences in the presence of healthy foods between April and July f(1,60) = 0.02, p > 0.05, ηp2 < 0.01). There was a significant time by FI interaction f(1,60) = 4.94, p < 0.05, ηp2 = 0.08), such that FI households reported significant decreases in healthy foods from April to July 2020 compared to FS households.

Conclusion: Our findings indicate significant decreases in healthy foods in FI households compared to FS households. Results are concerning as FI is increasing across the nation. Further, the impact of disease and economic burden from the COVID-19 pandemic disproportionately affects low-income families. Results may be informative regarding policy measures to ease the economic burden caused by the pandemic, such as increased SNAP benefits.

Objective: This study examined how stress experienced during the COVID-19 pandemic influenced mental well-being and weight loss behaviors among adults enrolled in an internet-based weight loss program.

Methods: Participants enrolled in a weight loss program completed a brief survey on how the COVID-19 pandemic influenced their current behaviors between April 14, 2020 and April 21, 2020. Participants were categorized based on stress level (High Stress: moderate to extreme stress, Low Stress: not at all to slightly stressed). Weight management behaviors were examined by stress category using independent sample t-tests for continuous variables or Chi-square tests for categorical variables.

Results: A total of 99 participants completed the survey (79% female, 91% white, 52.2±9.8 years, 34.0±5.2 kg/m2, 72% classified as High Stress). Individuals with High Stress were more likely to have school age children at home (p=0.004), experience higher levels of anxiety and concern regarding COVID-19 (p<0.05), have less time to spend on weight loss efforts (p<0.001), and more difficulty staying on track with eating habits (p<0.05) than those with Low Stress. No differences were seen for exercise habits.

Conclusions: Many individuals enrolled in a weight loss program experienced high stress during COVID-19. These high levels of stress were related to more difficulties finding time for weight management efforts and staying on track with eating habits, but not exercise habits.

Objectives: Emotional eating has been associated with overeating and greater consumption of energy-dense foods among youth. The current study examined the interactive effects of parental feeding practices and adolescent emotional eating on fruit and vegetable (F&V) intake among African American (AA) adolescents and hypothesized that more positive parenting practices (less restriction) would buffer the effects of emotional eating on dietary outcomes.

Methods: Overweight AA adolescents (N=125; M age 12.82±1.728; M BMI %ile 96.69±4.00) provided baseline data for the Families Improving Together for weight loss trial. Adolescents completed the Three-Factor Eating Questionnaire to assess emotional eating. F&V intake was assessed with random 24-hour dietary recall on two weekdays and one weekend day. Adolescents’ perspective on parental feeding practices was measured with the Child Feeding Questionnaire.

Results: A hierarchical linear regression demonstrated that the overall model was marginally significant (F(16,124)=1.576, p=0.088, R2=0.189) and indicated a significant interaction between emotional eating and parental monitoring (β=0.313, p=0.011), parental restriction (β=-0.241, p<0.05), and parental weight-related concerns (β=-0.293, p=0.008). Simple slope analyses showed that at high levels of parental monitoring, emotional eating was positively associated with greater F&V intake, at low levels of parental restriction, emotional eating was positively associated with higher F&V intake, and at low levels of parental concern, emotional eating was positively associated with higher F&V intake.

Conclusions: These findings expand past research and indicate that future studies may need to take parental feeding practices into account when evaluating the relationship between emotional eating and dietary outcomes among overweight AA adolescents.

Objective: For individuals with diabetes and household food insecurity (HFI), uncertain availability of food may increase fear of hypoglycemia (FOH). FOH may prevent individuals from optimal diabetes management.

Methods: We analyzed data from 1,603 adults (80% type 1 diabetes [T1D], 20% type 2 diabetes [T2D]) and 592 youth (100% T1D) participants in the SEARCH for Diabetes in Youth Study. Adult participants and parents of youth completed the US Household Food Security Survey, where ≥3 food insecure conditions indicate HFI. Adults, youth, and parents of youth completed the Hypoglycemia Fear Survey that provides a behavior subscale, worry subscale, and total score. We examined the association of HFI with FOH with general linear models, adjusting for covariates.

Results: Adults with T1D reporting HFI had increased FOH (+3 units for behavior, +11 units for worry, +14 units for total), after adjustment (all p<0.0001). Parents of youth with T1D reporting HFI had a 3 unit increase in worry FOH (p=0.03). Adults with T2D reporting HFI had increased FOH (+8.9 units for total, +6 units for worry; all p<0.01). Youth with T1D reporting HFI did not differ in FOH than those not reporting HFI.

Conclusion: This research suggests among adults with diabetes and parents of youth with T1D, those with HFI are more likely to experience FOH than those without HFI. Implementation of common approaches to ameliorate risk of hypoglycemia such as carrying snacks is problematic for people who are food insecure. Providers could consider HFI when discussing hypoglycemia and fear thereof with their patients.

Objective: This study examined the situation of existing adolescent nutrition services and needs of the service providers and recipients in hard-to-reach areas in Bangladesh.

Methods: This cross-sectional study design has used a mixed-method approach in five different types of hard-to-reach areas: haor, char (alluvial lands), islands, hilly and coastal areas spreading over 12 districts in Bangladesh. Situation analysis was large dependent on quantitative data which were collected by face-to-face interviews from 293 adolescent boys and girls. Need assessment was mostly appraised by qualitative data collection tools like Focus Group Discussions (FGDs), Key Informant Interviews (KIIs) and observations in 29 government health facilities.

Results: Approximately, 71% of adolescent girls sought nutrition services from government health facilities whereas no boys were found receiving any nutrition services from any kind of facilities. The coverage of IFA supplementation (66.7%), counseling on reproductive health and personal hygiene (33.3%) was found higher in the coastal areas though utilization of Behaviour Change Communication (BCC) materials while counseling was nil at all. The ceaseless demands for regular supply of nutrients, logistics and increasing skilled manpower at the field level were strongly uttered by both healthcare providers and recipients. Establishment of community nutrition clubs and improving school based nutrition services can play significant role in this regard.

Conclusion: Nutrition interventions implemented in hard-to-reach areas targeted the adolescent girls, leaving the adolescent boys bereft of the advantages of interventions. Strengthening the provision of nutrients supplementation and increasing the coverage of training are indispensable to improve nutrition services in hard-to-reach areas.

Introduction: Restricting dietary sodium consumption decreases arterial stiffness in adults, partially due to the blood pressure lowering effect of sodium restriction. We have shown that sodium consumption and blood pressure were not associated in women soon after delivery, but the relationship of sodium consumption and arterial stiffness in women shortly after pregnancy is unclear.

Objectives: The purpose of this investigation was to determine whether self-reported sodium consumption was associated with arterial stiffness in women 6 months to 3 years after a singleton birth.

Methods: Sodium consumption was measured using a validated scored sodium questionnaire. Arterial stiffness (pulse wave velocity) was obtained by dividing the distance between carotid and femoral arterial waveforms by the R wave of a simultaneously recorded ECG using a SphygmaCor machine and software. Associations were determined using robust linear regression, unadjusted and adjusted for age and race.

Results: 44 participants completed the study (20.45% African American, age=33±1 yrs, BMI=26±1 kg/m2). Pulse wave velocity was negatively associated with sodium consumption (r=-0.01, p=0.04) in an unadjusted analysis. After adjusting for race and age, the association was no longer significant (r=-0.01, p=0.11).

Conclusion: Arterial stiffness and sodium consumption were negatively and significantly associated, but the significance was lost after adjusting for age. Our data suggest that the negative association was likely mediated by age-related differences in arterial stiffness and sodium consumption in women in our study. Future work should investigate associations of arterial stiffness and sodium consumption in a larger cohort or determine the effect of sodium restriction on arterial stiffness of women soon after delivery.

Objectives: People under stress tend to use unhealthy coping mechanisms including using products like alcohol, tobacco and unhealthy snacks. The purpose of this study is to assess how measures of community socio-economic status, which may be proxies for community stress, are associated with the sales of unhealthy products (alcohol, tobacco, and unhealthy snacks) at a discount variety store chain. Specifically, we consider the following measures of community socio-economic status: population racial/ethnic composition, percent of households on SNAP, percent of households without a vehicle, walkability score and median community income.

Methods: Mixed effects linear regressions with random effects were used to examine the relationship between the weekly unit sales (per 1000 population) of three outcome variables (tobacco, alcohol, unhealthy snacks) and community socio-economic factors: percent of households on SNAP, percent of households without a vehicle, and median community income. Alcohol, tobacco, and unhealthy snack sales were collected over a 20-month period in 2017 and 2018 in 16 discount variety stores.

Results: The sales of alcohol, tobacco, and unhealthy snacks increased as the percent of the population participating in SNAP increased. Other measures of community socio-economic status were not significantly (at 5% significance level) associated with tobacco or unhealthy snack sales. However, for alcohol sales, increases in: the median household income, walkability score and percent of African American residents, were associated with a decrease in alcohol sales.

Conclusions: Low income neighborhoods frequently experience greater health burden compared to higher income neighborhoods. Understanding and quantifying the relationship between financial stress and unhealthy product consumption can help public health professionals intervene before chronic diseases manifest.

Objectives: Serum biomarkers are a common measurement of exposure to dietary antioxidants and may be considered superior to dietary assessment data given their relative objectivity. However, their associations with cancer risk have not been systematically reviewed and compared within the same study population. Therefore, we aimed to evaluate the consistency of the associations with cancer risk between dietary and serum antioxidant nutrients.

Methods: We searched the database of PubMed, Web of Science, and Embase to obtain studies that investigated the association between dietary and serum vitamins A, C, and E, and total carotenoids with cancer risk using the same study population in prospective designs. We abstracted the results from each paper using a standard data extraction table and compared the results for dietary intake and serum concentration of the antioxidant nutrients in relation to all cancer types.

Results: After scanning 17,394 records from the literature search, we obtained 28 prospective studies involving 54 associations focused on both dietary intake and serum level of antioxidants within the same study population. The associations between cancer risk and antioxidants assessed by dietary intake and serum antioxidant concentration were consistent in 38 results (total observed agreement = 0.704) when using p-value linear trend <= 0.05 as the cut-point. Cancer risk was not associated with extreme categories of antioxidants measured by dietary intake or serum levels.

Conclusions: Generally, associations between dietary antioxidants intake and cancer risk are consistent with those for serum antioxidants when examined within the same study population.